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Category Archives: Drug Interactions

Unfortunately mixing alcohol with certain types of prescription medications can be dangerous.  Alcohol can increase the risk of severe CNS depression when taken with opioids, benzodiazepines and barbituates.  Alcohol can also affect drug metabolism (breakdown to active components), or the absorption of some drugs. Chronic alcohol intake can also cause problems with certain medications because of the effect it has on the liver and specific drug metabolizing enzymes.

Chronic alcohol use increases acetaminophen (Tylenol) metabolism increasing its conversion to metabolites toxic to the liver.  It is always best not to exceed four grams of acetaminophen a day, especially if you are a heavy or binge drinker because of the damage it can due to your liver.

Chronic alcohol use along with NSAIDS (Ibuprofen) or aspirin can increase the risk of GI bleeds.  However, an occasional drink with NSAID use is not likely an issue.

If you are a patient on warfarin alcohol can inhibit warfarin metabolism and increase your INR.  If you change your usual alcohol intake you should have your INR checked.

Certain antibiotics, and in particular metronidazole, has the potential when mixed with alcohol to make people quite ill.  When taken to together a patient may experience low blood pressure, shortness of breath, facial flushing, and nausea.

Diabetic patients taking hypoglycemics such as Glyburide or insulin are at risk of severe hypoglycemia (low blood sugar) when they drink alcohol.  These patients should limit alcohol to an occasional single drink.

Any patient on medication for sleeping should be careful of alcohol consumption because of the additive affects of drowsiness and respiratory depression.    Patients have been known to aspirate their own vomit and die from intoxication.  This could be more likely to happen if a person mixes alcohol with their sleep medication.

This same problem could exist when patients mix alcohol and opiates.

It is always wise to consult your pharmacist or physician if you receive a new prescription and intend to have a few alcoholic beverages.  Also please notify your physician or pharmacist if you are a chronic drinker.  Even if you are not planning to drink while taking your prescription previous liver damage could affect how well you metabolize your medication.  This could result in too high, or too low a dose for you.

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Many patients have concerns about drug interactions. There are several types of interactions but only a few of these are critical enough to require a change in medication or dosing.

Patients are usually most concerned about whether they can take their medication at the same time. In general, this is not a problem and not what we are referring to when we say your medications could interact. This being said, there are a few incidences where medications should not be taken together. Some drugs can bind together and not get absorbed. An antibiotic called ciprofloxacin and iron are an example. If the two are taken together the antibiotic may not be absorbed leaving the patient’s infection untreated. In general if your doctor has prescribed a fluoroquinolone antibiotic (eg. Cipro, Levaquin, Avelox) you should take that medication by itself with a glass of water, avoiding milk products, calcium, antacids, and iron products.

Other medications that should be taken on an empty stomach include Synthroid or Eltroxin, Actonel, or Fosamax, and most of the proton pump inhibitors, such as Losec (omeprazole) and Pariet (rabeprazole).

Most medication can be taken at the same time, whenever it is convenient for you. The interactions we are concerned with have more to do with how the medication is processed than with its absorption. Medication is metabolized by certain enzymes in your liver, kidneys, blood, and sometimes your lungs. When drugs interact, the first drug will affect an enzyme that the second drug needs to be metabolized by. For example, Drug A could inhibit Enzyme Y, which is important in metabolizing Drug B. As a result the concentration of Drug B may become too high and cause unwanted side effects.

As a patient you should double check with your pharmacist regarding interactions if you are taking warfarin, digoxin, levothyroxine, lithium, carbamazepine, phenytoin or theophylline. Small increases in these drugs can cause toxicity.

If you are taking an MAOI (Manerix, Nardil, Parnate), combining that with another antidepressant or even pseudoephedrine, found in most cold medications can have serious consequences.

An antibiotic called Biaxin can interact with cholesterol medication like Lipitor. Usually the doctor will discontinue the cholesterol medication while you are on the antibiotic, or decrease the dose of the cholesterol medication. Patients should avoid a combination of nitrates and Viagra, Levitra, or Cialis. This combo can cause severely low blood pressure.

Ketoconazole, (an antifungal), erythromycin (an antibiotic) and rifampin (another type of antibiotic), often interact with a number of medications. Check with the pharmacist or doctor if you are to start one of these medications. Certain foods and herbal products are also known to interact with medications. Grapefruit juice affects certain cholesterol and blood pressure medications. Separating grapefruit juice from the time you take the medication will not prevent the problem since the juice will inhibit the enzymes on a continual twenty-four hour basis. Alcohol should not be mixed with an antibiotic called Flagyl (metronidazole), or with other medications already known to make you drowsy. Examples would include narcotics and sleeping aids.

St. John’s Wort is known to interact with many medications. It can even interrupt the effectiveness of the birth control pill. It is best to talk to your doctor before starting any herbal treatment. This is especially true if you are taking warfarin, herbals can affect your INR and increase your risk of bleeding.

Antibiotics were once thought to affect the birth control pill. While there is some debate on the subject, a second method of birth control should be use when you start your antibiotic.

Certain types of blood pressure medications when taken together can increase your potassium. Too much potassium can lead to heart problems. If you are seeing more than one doctor, (i.e a specialist and your family doctor) and they are both prescribing medications, check with your pharmacist to ensure there are no problems.

Recently there has been concern that certain proton pump inhibitors (PPIs) might decrease the efficacy of Plavix. It seems that Losec may cause the most problems. Pantoloc seems less likely to interact. If you are on Plavix and a PPI it may be wise to consult your physician to determine if this a problem for you. Most drugs do not interact. The ones listed above are exceptions to that rule. If you are concerned please consult your pharmacist or physician.